UPMC Physician Resources

Computer Simulation Predicts Development, Progress of Pressure Sores

PITTSBURGH, June 25, 2015 – Researchers at the University of Pittsburgh School of Medicine have devised a computational model that could enhance understanding, diagnosis and treatment of pressure ulcers related to spinal cord injury. In a report published online in PLOS Computational Biology, the team also described results of virtual clinical trials that showed that for effective treatment of the lesions, anti-inflammatory measures had to be applied well before the earliest clinical signs of ulcer formation.

Pressure ulcers affect more than 2.5 million Americans annually and patients who have spinal cord injuries that impair movement are more vulnerable to developing them, said senior investigator Yoram Vodovotz, Ph.D., professor of surgery and director of the Center for Inflammation and Regenerative Modeling at the Pitt School of Medicine.

“These lesions are thought to develop because immobility disrupts adequate oxygenation of tissues where the patient is lying down, followed by sudden resumption of blood flow when the patient is turned in bed to change positions,” Dr. Vodovotz said. “This is accompanied by an inflammatory response that sometimes leads to further tissue damage and breakdown of the skin.”

“Pressure ulcers are an unfortunately common complication after spinal cord injury and cause discomfort and functional limitations,” said co-author Gwendolyn A. Sowa, M.D., Ph.D., associate professor of physical medicine and rehabilitation, Pitt School of Medicine. “Improving the individual diagnosis and treatment of pressure ulcers has the potential to reduce the cost of care and improve quality of life for persons living with spinal cord injury.”

To address the complexity of the biologic pathways that create and respond to pressure sore development, the researchers designed a computational, or “in silico,” model of the process based on serial photographs of developing ulcers from spinal cord-injured patients enrolled in studies at Pitt’s Rehabilitation Engineering Research Center on Spinal Cord Injury. Photos were taken when the ulcer was initially diagnosed, three times per week in the acute stage and once a week as it resolved.

Then they validated the model, finding that if they started with a single small round area over a virtual bony protuberance and altered factors such as inflammatory mediators and tissue oxygenation, they could recreate a variety of irregularly shaped ulcers that mimic what is seen in reality.

They also conducted two virtual trials of potential interventions, finding that anti-inflammatory interventions could not prevent ulcers unless applied very early in their development.

In the future, perhaps a nurse or caregiver could simply send in a photo of a patient’s reddened skin to a doctor using the model to find out whether it was likely to develop into a pressure sore for quick and aggressive treatment to keep it from getting far worse, Dr. Vodovotz speculated.

“Computational models like this one might one day be able to predict the clinical course of a disease or injury, as well as make it possible to do less expensive testing of experimental drugs and interventions to see whether they are worth pursuing with human trials,” he said. “They hold great potential as a diagnostic and research tool.”

The team included co-senior author Gary An, M.D., of the University of Chicago; Cordelia Ziraldo, Ph.D., Alexey Solovyev, Ph.D., Ana Allegretti, Ph.D., Shilpa Krishnan, M.S., David Brienza, Ph.D., Qi Mi, Ph.D., all of Pitt; and M. Kristi Henzel, M.D., Ph.D., of the Louis Stokes Cleveland Veterans Affairs Medical Center.

The project was funded by the U.S. Department of Education; National Institutes of Health National Institute on Disability and Rehabilitation Research grant H133E070024; and an IBM Shared University Research Award.

USA Hockey Honors UPMC Surgeon Charles “Chip” Burke III with Excellence in Safety Award

PITTSBURGH, June 25, 2015Charles “Chip” Burke III, M.D. of Fox Chapel, was honored with the Excellence in Safety Award at the 2015 USA Hockey’s Annual Congress’ Night of Tribute Awards Dinner. Dr. Burke was recognized for his outstanding contributions in improving safety and reducing injury in youth sports through his 20-year association with USA Hockey.

Dr. Burke, a UPMC orthopaedic surgeon and clinical associate professor at the University of Pittsburgh School of Medicine, has been combining his profession as an orthopaedic surgeon with his passion for the sport of ice hockey at all levels for more than 30 years. His decades of volunteering with USA Hockey have led him to a number of positions, including being a 15-year member of the Safety and Protective Equipment Committee and team physician for the 2002 Winter Olympics. He also has served as part of the Coaching Education Program, teaching coaches about safety in youth sports.

During Dr. Burke’s 25 years as team physician with the Pittsburgh Penguins of the National Hockey League (NHL), he made his most notable contribution to NHL safety by developing the NHL Concussion Program, the largest study of head injuries in sports. The 7-year initiative analyzed head injuries, making large strides in the understanding of concussions. He is past president of the NHL Team Physician’s Society (NHLTPS) and chaired the NHLTPS Injury Committee for many years.

Dr. Burke also was actively involved in establishing the UPMC Sports Medicine Concussion Program in 2000, the first and largest program of its kind, widely considered as the national leader in concussion care and treatment. The center sees patients of all ages and athletic ability, testing for and treating head injuries from a multidisciplinary approach.

“I’ve dedicated my life to making hockey safer so we have fewer injuries,” said Dr. Burke of his decades of work in the game. “Accomplishing this would allow kids to participate more often without injuries that could affect their futures outside of sports. Between USA Hockey and all the work I’ve done with the NHL and UPMC, that’s always been my goal—to give back to the sport.”

USA Hockey relies on volunteers to continue promoting youth sports as a means of providing life lessons hard to find elsewhere. Dr. Burke believes the goal of USA Hockey is not simply to create elite athletes, but to educate and develop the young participants through competition and hard work.

Dr. Burke grew up in Boston playing hockey in a backyard rink with his five brothers. He attended Harvard College, earning a varsity letter in ice hockey. Three of his brothers also lettered in collegiate hockey, two at Harvard and one at Notre Dame.

Dr. Burke practices at Burke and Bradley Orthopedics at UPMC St. Margaret.

Pitt’s Dr. Yuan Chang Appointed to National Cancer Advisory Board

PITTSBURGH, June 23, 2015 – President Barack Obama recently appointed a pathologist in the University of Pittsburgh Cancer Institute (UPCI), partner with UPMC CancerCenter, to a national board charged with identifying the most promising cancer research projects nationwide.

Yuan Chang, M.D., Distinguished Professor of Pathology in Pitt’s School of Medicine, has been Dr. Yuan Changappointed with four other scientists to serve as members of the National Cancer Advisory Board.

“I am honored that these talented individuals have decided to serve our country. They bring their years of experience and expertise to this administration, and I look forward to working with them,” President Obama said in announcing the appointments.

The National Cancer Advisory Board consists of 12 members appointed by the president to advise the National Institutes of Health’s (NIH) National Cancer Institute. The members review applications for grants and cooperative agreements for cancer research and training, and recommend approval of the projects that show the most promise of making valuable contributions to human knowledge.

“This is a great opportunity for me to professionally contribute to the directive of the National Institutes of Health,” said Dr. Chang, also UPMC Professor of Cancer Virology Research. “My goal is to bring my basic research expertise on infectious diseases and cancer to inform the administrative goals of the NIH.”

Dr. Chang joined the Pitt School of Medicine in 2002, after she and Patrick S. Moore, M.D., M.P.H., discovered Kaposi’s sarcoma-associated herpesvirus, which causes Kaposi’s sarcoma, the most common malignancy occurring in AIDS patients. The team then went on to discover Merkel cell polyomavirus, which causes a rare but deadly skin cancer.

Dr. Chang earned her Bachelor of Science degree from Stanford University and a medical doctorate from the University of Utah College of Medicine.

Prior to coming to Pitt, Dr. Chang served in several clinical and academic positions from 1993 to 2002 at the Columbia University College of Physicians and Surgery and Columbia Presbyterian Hospital. Before that she was a clinical instructor at Stanford University Medical Center.

Image credit: Joshua Franzos

Gene Therapy Prevents Parkinson’s Disease in Animal Model, Says Pitt Study

PITTSBURGH, June 15, 2015 – Gene therapy to reduce production of a brain protein successfully prevented development of Parkinson’s disease in an animal study, according to researchers at the University of Pittsburgh School of Medicine. The findings, published online today in the Journal of Clinical Investigation, could lead to new understanding of how genetic and environmental factors converge to cause the disease, and the development of effective treatments to prevent disease progression.

Scientists have observed dysfunction of mitochondria, which make energy for cells, in Parkinson’s disease, as well as Lewy parkinsons
bodies, which are characteristic clumps of the cellular protein α-synuclein within neurons, said principal investigator Edward A. Burton, M.D., D.Phil., associate professor of neurology, Pitt School of Medicine.

“Until now, these have been pursued largely as separate lines of research in Parkinson’s disease,” Dr. Burton said. “Our data show that mitochondria and α-synuclein can interact in a damaging way in vulnerable cells, and that targeting α-synuclein might be an effective strategy for treatment.”

The team wanted to see what would happen if they knocked out the production of α-synuclein in the brain’s substantia nigra, home to the dopamine-producing cells that are lost as Parkinson’s disease progresses. To do so, they used a harmless virus called AAV2 engineered to transport into the neuron a small piece of genetic code that blocks production of α-synuclein. They delivered the gene therapy to the brains of rats and then exposed the animals to the pesticide rotenone, which inhibits mitochondrial function.

“Our previous work established that rotenone exposure in rats reproduces many features of Parkinson’s disease that we see in humans, including movement problems, Lewy bodies, loss of dopamine neurons and mitochondrial dysfunction,” explained co-investigator J. Timothy Greenamyre, M.D., Ph.D., Love Family Professor of Neurology, and director of the Pittsburgh Institute for Neurodegenerative Diseases at Pitt. “We found that our gene therapy prevented those symptoms from appearing, which is very exciting.”

Each side of the brain controls the opposite side of the body.  The left sides of rats that received gene therapy to the right side of the brain did not become stiff and slow, while their right sides did. The researchers determined that dopamine neurons on the treated side of the brain were protected from rotenone, accounting for the substantial improvement in movement symptoms. In contrast, untreated animals and animals that received a control virus that does not reduce α-synuclein production, developed progressive Parkinsonism and loss of dopamine neurons.

In next steps, the researchers plan to unravel the molecular pathways that enable α-synuclein levels to influence mitochondrial function and develop drugs that can target the underlying mechanisms.

“The viral vector AAV2 has been used safely in Parkinson’s disease patients in clinical trials, so the gene therapy approach might be feasible,” Dr. Burton said. “We think targeting α-synuclein has great potential to protect the brain from neurodegeneration in Parkinson’s disease.”

“We hope to be able to translate this general approach of reducing α-synuclein into human clinical trials soon,” Dr. Greenamyre added.

The team included Alevtina Zharikov, Ph.D., Jason R. Cannon, Ph.D., Victor Tapias, Ph.D., Qing Bai, Ph.D., Max Horowitz, M.D., Ph.D., Vipul Shah, M.D., Amina El Ayadi, Ph.D., and Teresa G. Hastings, Ph.D., all of the University of Pittsburgh.

The project was funded by the U. S. Department of Veterans Affairs grant 1I01BX000548;  National Institutes of Health grants ES022644, NS059806, ES018058, ES020718, ES019879 and ES020327; the Blechman Foundation; the Parkinson’s Chapter of Greater Pittsburgh; the JPB Foundation; the American Parkinson Disease Association; the Parkinson’s Unity Walk; and a gift from Mr. and Mrs. Henry Fisher.

Pitt Researchers Find Genetic Testing in Thyroid Cancer May Aid in Surgical Decision Making

PITTSBURGH, June 10, 2015 – A team of researchers led by Linwah Yip, MD, associate professor in the Department of Surgery, recently found that routine genetic testing to detect mutations implicated in thyroid carcinogenesis can help guide perioperative decision making.  Their research recently was presented by Dr. Yip at the annual meeting of the American Surgical Association in San Diego.

Dr. Yip and her colleagues at the University of Pittsburgh conducted a retrospective review of a consecutive series of 1,510 patients from the electronic medical record of a single institution. The patients had initial surgery for histologically confirmed thyroid cancer. All cancers in the study were tested for mutations in seven genes associated with thyroid carcinogenesis. Although risks associated with mutations are not always clear-cut, the researchers found that distant metastases were more common in thyroid cancer patients who were positive for the RET/PTC mutation, while thyroid cancer expressing BRAF V600E or RET/PTC was associated with higher-grade cancer on presentation and early recurrence.

Additional researchers on the study were Marina N. Nikiforova, MD, Jenny Yoo, MD, Kelly L. McCoy, MD, Michael T. Stang, MD, Kristina J. Nicholson, MD, Michaele J. Armstrong, PhD, Steven P. Hodak, MD, Robert L. Ferris, MD, PhD, Yuri E. Nikiforov, MD, PhD, Sally E. Carty, MD, all currently or formerly of the University of Pittsburgh.

For more information, please visit the American College of Surgeons webpage.

Children’s Hospital of Pittsburgh of UPMC Named One of America’s Top 10 Children’s Hospitals for Sixth Consecutive Year

PrintPITTSBURGH, June 9, 2015 – Children’s Hospital of Pittsburgh of UPMC has once again been named one of America’s Best Children’s Hospitals by U.S. News & World Report, making this the sixth consecutive year the hospital has been listed on the Honor Roll.

Children’s Hospital ranks eighth on the magazine’s 2015-16 Honor Roll of America’s Best Children’s Hospitals, which was released today. Children’s also ranks in each of the 10 pediatrics specialties ranked by U.S. News.

The Best Children’s Hospitals rankings highlight the top 50 U.S. pediatric hospitals in each of 10 specialties: cancer; cardiology and heart surgery; diabetes and endocrinology; gastroenterology and GI surgery; neonatology; nephrology; neurology and neurosurgery; orthopedics; pulmonology; and urology.

The hospital ranked in the top 25 in nine of the specialties, including second in gastroenterology and GI surgery; third in diabetes and endocrinology; sixth in pulmonology; and 10th in three categories: cardiology and heart surgery, neonatology, and neurology and neurosurgery.

“This recognition speaks to the talent, passion, and dedication of our physicians, nurses, staff, and volunteers,” said Christopher Gessner, president, Children’s Hospital. “We are proud to have built a reputation of excellence over our 125-year history and we’re grateful to have those efforts recognized.”

The 2015-16 Best Children’s Hospitals rankings will be released online today and also will be published in the U.S. News “Best Hospitals 2016” guidebook, available in September.

U.S. News introduced the Best Children’s Hospitals rankings in 2007 to help families of children with rare or life-threatening illnesses find the best medical care available. The rankings open the door to an array of detailed information about each hospital’s performance.

In addition to Children’s Hospital of Pittsburgh of UPMC, the other hospitals named to U.S. News’ Honor Roll of Best Children’s Hospitals for 2015-16 are:

  • Boston Children’s Hospital
  • Children’s Hospital of Philadelphia
  • Cincinnati Children’s Hospital Medical Center
  • Texas Children’s Hospital, Houston
  • Children’s Hospital Colorado, Aurora
  • Seattle Children’s Hospital
  • Children’s Hospital Los Angeles
  • Nationwide Children’s Hospital, Columbus, Ohio
  • Children’s National Medical Center, Washington, D.C.
  • Ann and Robert H. Lurie Children’s Hospital of Chicago
  • Children’s Healthcare of Atlanta

Children’s Hospital of Pittsburgh of UPMC and Its Foundation Celebrate 125 Years of Caring

PrintPITTSBURGH, June 4, 2015 – Children’s Hospital of Pittsburgh of UPMC opened its doors on June 4, 1890, and today kicks off a yearlong celebration of 125 years of caring for kids.

From our beginning — a single cot endowed by Kirk LeMoyne, son of local pediatrician Frank LeMoyne, to be used for children and infants at a local hospital — to present day, Children’s Hospital has grown to become one of the world’s top pediatric hospitals with a reputation for innovation as well as superior care and successful treatment of kids with highly complex medical issues.

Children’s medical team treats rare diseases, defines new standards of care, pioneers research and treatment protocols, and provides patient- and family-centered services in a top-of-class environment. Every discovery, milestone and advancement is rooted in the same mission and supported by the same essence of community philanthropy established 125 years ago.

“Today, with 125 Years of Caring, we celebrate the tremendous work of our staff and physicians and all that they do for patients and families in the region,” said Christopher Gessner, president, Children’s Hospital. “We are extremely grateful for the generous community support that enables us to continue to provide the world-class care that has catapulted Children’s to the forefront of pediatric health care.”

Throughout the year, Children’s Hospital of Pittsburgh Foundation will carry on a campaign — “Give Kids a Chance to be Kids” — celebrating 125 years of caring and the important role of community support for the clinical and research advances at Children’s. The campaign will raise funds for patient care and research, attract a new generation of support from leading organizations and individuals throughout the region and beyond, and engage the community with a collective goal: Cures for childhood illness and diseases.

“The 125th anniversary will celebrate Children’s Hospital’s history and build momentum for what can be accomplished for our children’s children with continued community support and engagement,” said Greg Barrett, president, Children’s Hospital of Pittsburgh Foundation. “Every gift, large or small, directly impacts the lives of children. By giving to Children’s, we truly are giving kids a chance to be kids.”

Today, Children’s officially began the celebration with a 125th anniversary kickoff event in the Eat’n Park Atrium at Children’s main campus in Lawrenceville. During the event, the Foundation announced a $1.25 million partnership with PNC as the lead corporate sponsor for the 125th Anniversary campaign. In addition, Jay Costa, State Senate Minority Leader; Wayne D. Fontana, State Senator, Democratic Caucus Chair; Rich Fitzgerald, Allegheny County Executive; and Bill Peduto, Mayor of Pittsburgh, all read proclamations.

Children’s Hospital of Pittsburgh Foundation also unveiled the “Giving Booth,” an interactive video booth that will travel throughout the region to various events encouraging individuals to share a childhood memory or a Children’s Hospital memory. All videos will be uploaded to the Foundation’s 125th Anniversary webpage where participants will be able to watch and share videos and encourage their friends and family to do the same, as well as make a donation to support Children’s. The 125th Anniversary webpage also will feature memories shared by local and national celebrities.

For more information on the Foundation and the campaign, visit www.givetochildrens.org/125.

Lower Birth Weight Associated with Proximity of Mother’s Home to Gas Wells

PITTSBURGH, June 3, 2015 – Pregnant women living close to a high density of natural gas wells drilled with hydraulic fracturing were more likely to have babies with lower birth weights than women living farther from such wells, according to a University of Pittsburgh Graduate School of Public Health analysis of southwestern Pennsylvania birth records.

The finding does not prove that the proximity to the wells caused the lower birth weights, but it is a concerning association that warrants further investigation, the researchers concluded. The study was funded by The Heinz Endowments and published in the current issue of PLOS ONE.

“Our work is a first for our region and supports previous research linking unconventional gas development and adverse health outcomes,” said co-author Bruce Pitt, Ph.D., chair of Pitt Public Health’s Department of Environmental and Occupational Health. “These findings cannot be ignored. There is a clear need for studies in larger populations with better estimates of exposure and more in-depth medical records.”

Unconventional gas development includes horizontal drilling and high volume hydraulic fracturing, known as “fracking.” It allows access to large amounts of natural gas trapped in shale deposits. Prior to 2007, only 44 wells were known to be drilled in Pennsylvania’s Marcellus Shale with such technology. From 2007 to 2010, that expanded to 2,864 wells.

The Pitt Public Health research team cross-referenced birth outcomes for 15,451 babies born in Washington, Westmoreland and Butler counties from 2007 through 2010 with the proximity of the mother’s home to wells drilled using unconventional gas development. They divided the data into four groups, depending on the number and proximity of wells within a 10-mile radius of the mothers’ homes.

Mothers whose homes fell in the top group for proximity to a high density of such wells were 34 percent more likely to have babies who were “small for gestational age” than mothers whose homes fell in the bottom 25 percent. Small for gestational age refers to babies whose birth weight ranks them below the smallest 10 percent when compared to their peers.

The researchers took into account many factors that could influence a newborn’s weight – including whether the mother smoked, her prenatal care, race, education, age and whether she’d had previous babies, as well as the gender of the baby – and the finding still held.

“Developing fetuses are particularly sensitive to the effects of environmental pollutants,” said Dr. Pitt. “We know that fine particulate air pollution, exposure to heavy metals and benzene, and maternal stress all are associated with lower birth weight.”

In southwestern Pennsylvania, the waste fluids produced through hydrofracturing, called “flowback,” can contain benzene. Unconventional gas development also creates an opportunity for air pollution through flaring of methane gas at the well heads and controlled burning of natural gas that releases volatile organic compounds, including benzene, toluene, ethylbenzene and xylene. Increased truck traffic and diesel-operated compressors also can contribute to air and noise pollution.

“It is important to stress that our study does not say that these pollutants caused the lower birth weights,” said Dr. Pitt. “Unconventional gas development is dynamic and varies from site to site, changing the potential for human exposure. To draw firm conclusions, we need studies that thoroughly assess the exposure of a very large number of pregnant women to not just the gas wells, but other potential pollutants.”

Shaina L. Stacy, Ph.D., a recent graduate of Pitt Public Health, is lead author on this research, and Evelyn Talbott, Dr.P.H., epidemiology professor at the school, is senior author. Additional authors are LuAnn L. Brink, Ph.D., and Bernard D. Goldstein, M.D., both of Pitt Public Health; and Jacob C. Larkin, M.D., and Yoel Sadovsky, M.D., both of Magee-Womens Research Institute and Pitt School of Medicine.

UPMC-Managed Transplant Hospital Drives Major Economic Benefits for Sicily, Study Finds

PITTSBURGH, May 28, 2015 ISMETT, a leading transplant hospital managed by UPMC in Palermo, Italy, boosted the Sicilian economy by €132.5 million in expenditure in 2013, generated nearly 2,000 jobs and provided a net benefit of more than €73 million by retaining patients who otherwise would have traveled outside of Sicily for care, according to a new study by the Battelle Memorial Institute. At the same time, the partnership with UPMC provided access to research, training and advanced health care management that is transforming Sicily into a biomedical hub for the entire Mediterranean basin.

Formally known as the Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, ISMETT has performed more than 1,600 transplants since it began operations in 1999. An unusual public-private partnership among UPMC, the Region of Sicily and Cervello and Civico hospitals, ISMETT is the only hospital in Italy designed and intended exclusively for solid organ transplantation and highly specialized therapies. It boasts patient survival rates that are among the best in Europe and treats more than 30,000 patients a year with severe organ disease.

“The results of this study reach beyond ISMETT and Sicily, and are evidence of the positive economic benefits generated when high-quality health care combines with cutting-edge research,” said Bruno Gridelli, M.D., chief executive officer of ISMETT and executive vice president of UPMC International Services. “When health care and its various elements—therapy, training and research—are properly managed, they can be powerful forces in the financial and social growth of an entire region.”

To identify and quantify the economic and social benefits of ISMETT for Sicily, UPMC commissioned this detailed analysis from Battelle’s Technology Partnership Practice. The study examined the direct impact of expenditures made by ISMETT, its employees and visitors, as well as the indirect, or multiplier, effects. The researchers also assessed the many and varied “functional impacts” of ISMETT, or those generated by its clinical services, research and development activity, and education of medical staff.

In 2013, the overall impact of ISMETT’s expenditures on the Sicilian economy included €67.9 million directly and €64.5 million through the indirect, multiplier effect. ISMETT and its related economic activities generated 1,793 jobs in Sicily—862 direct and 931 indirect. Battelle estimated that Sicily receives €3.1 million in annual taxes because of ISMETT’s operations, while the Italian national government receives approximately € 19.6 million annually.

As expected when ISMETT was created, the hospital’s presence has reversed the trend of Sicilian patients traveling abroad to receive transplants and high-specialty care, which means more convenience for patients and their families and significant savings for the regional government. According to Battelle, the presence and operation of ISMETT retained a net €73.2 million in the Sicilian economy that otherwise would have been spent outside the region to pay for care, patient transportation and associated costs. Ninety-two percent of ISMETT’s patients are from Sicily, while the rest come from other Italian regions or from abroad.

ISMETT also is an institution that is helping Sicily to build a reputation for science, technological advancement, research and specialty medical training. This has helped to pave the way for the planned Biomedical Research and Biotechnology Center in Carini, which will employ more than 600 people when it opens in 2017. The government-funded center will operate under the leadership of the Ri.MED Foundation, a partnership of UPMC, the government of Italy, the Region of Sicily and the Italian National Research Council.

“Originally seen as an institution that would fill a gap in clinical services in Italy, ISMETT has succeeded beyond our expectations and has grown to become a major economic engine for the Sicilian economy,” said Dr. Gridelli. “Most importantly, ISMETT is improving the well-being of patients throughout Italy and beyond and promises to advance health and science for years to come.”

Fine Particulate Air Pollution Associated With Increased Risk of Childhood Autism

PITTSBURGH, May 21, 2015 – Exposure to fine particulate air pollution during pregnancy through the first two years of a child’s life may be associated with an increased risk of the child developing autism spectrum disorder (ASD), a condition that affects one in 68 children, according to a University of Pittsburgh Graduate School of Public Health investigation of children in southwestern Pennsylvania.

The research is funded by The Heinz Endowments and published in the July edition of Environmental Research.

“Autism spectrum disorders are lifelong conditions for which there is no cure and limited treatment options, so there is an urgent need to identify any risk factors that we could mitigate, such as pollution,” said lead author Evelyn Talbott, Dr.P.H., professor of epidemiology at Pitt Public Health. “Our findings reflect an association, but do not prove causality. Further investigation is needed to determine possible biological mechanisms for such an association.”

Dr. Talbott and her colleagues performed a population-based, case-control study of families with and without ASD living in six southwestern Pennsylvania counties. They obtained detailed information about where the mothers lived before, during and after pregnancy and, using a model developed by Pitt Public Health assistant professor and study co-author Jane Clougherty, Sc.D., were able to estimate individual exposure to a type of air pollution called PM2.5.

This type of pollution refers to particles found in the air that are less than 2.5 micrometers in diameter, or 1/30th the average width of a human hair. PM2.5 includes dust, dirt, soot and smoke. Because of its small size, PM2.5 can reach deeply into the lungs and get into the blood stream. Southwestern Pennsylvania has consistently ranked among the nation’s worst regions for PM2.5 levels, according to data collected by the American Lung Association.

“There is increasing and compelling evidence that points to associations between Pittsburgh’s poor air quality and health problems, especially those affecting our children and including issues such as autism spectrum disorder and asthma,” said Grant Oliphant, president of The Heinz Endowments. “While we recognize that further study is needed, we must remain vigilant about the need to improve our air quality and to protect the vulnerable. Our community deserves a healthy environment and clean air.”

Autism spectrum disorders are a range of conditions characterized by social deficits and communication difficulties that typically become apparent early in childhood. Reported cases of ASD have risen nearly eight-fold in the last two decades. While previous studies have shown the increase to be partially due to changes in diagnostic practices and greater public awareness of autism, this does not fully explain the increased prevalence. Both genetic and environmental factors are believed to be responsible.

Dr. Talbott and her team interviewed the families of 211 children with ASD and 219 children without ASD born between 2005 and 2009. The families lived in Allegheny, Armstrong, Beaver, Butler, Washington and Westmoreland counties. Estimated average exposure to PM2.5 before, during and after pregnancy was compared between children with and without ASD.

Based on the child’s exposure to concentrations of PM2.5 during the mother’s pregnancy and the first two years of life, the Pitt Public Health team found that children who fell into higher exposure groups were at an approximate 1.5-fold greater risk of ASD after accounting for other factors associated with the child’s risk for ASD – such as the mother’s age, education and smoking during pregnancy. This risk estimate is in agreement with several other recent investigations of PM2.5 and autism.

A previous Pitt Public Health analysis of the study population revealed an association between ASD and increased levels of air toxics, including chromium and styrene. Studies by other institutions using different populations also have associated pollutants with ASD.

“Air pollution levels have been declining since the 1990s; however, we know that pockets of increased levels of air pollution remain throughout our region and other areas,” said Dr. Talbott. “Our study builds on previous work in other regions showing that pollution exposures may be involved in ASD. Going forward, I would like to see studies that explore the biological mechanisms that may underlie this association.”

Additional co-authors of this study are Vincent C. Arena, Ph.D., Judith R. Rager, M.P.H., Drew R. Michanowicz, Dr.P.H., Ravi K. Sharma, Ph.D., and Shaina L. Stacy, Ph.D., all of Pitt Public Health.

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